手部电烧伤的皮瓣修复

Repair of electrical burns on hands with flaps

目的总结用皮瓣修复手部电烧伤创面的经验与不足，以期不断完善。方法收集整理2000年1月-2006年12月武汉市第三医院暨武汉大学同仁医院烧伤研究所收治的425例手部电烧伤患者资料，统计分析其治疗概况及结果，归纳总结行皮瓣移植术患者的皮瓣类型、术后并发症及存在的问题。根据皮瓣修复手术时机，将患者分为受伤7d内手术组和受伤7d后手术组，比较2组患者皮瓣成活率及并发症发生率。结果425例患者中，348例行手术治疗占90．2％，其中209例行不同类型皮瓣移植共248例次，包括远位带蒂皮瓣202例次占81．5％、局部皮瓣19例次占7．7％、游离皮瓣12例次占4．8％、其他类型组织瓣15例次占6．0％。5例因皮瓣撕脱或坏死改用其他方法治疗。8例皮瓣远端少许坏死，经换药或补植小皮片后愈合。其余皮瓣均完全成活，创面一次修复，功能及外观较满意。受伤7d内手术组（170例次）和受伤7d后手术组（78例次）患者，皮瓣成活率分别为98．8％（168／170）及96．2％（75／78），并发症发生率分别为10．6％（18／170）及12．8％（10／78），两指标组间比较，差异均无统计学意义（χ^2值分别为0．81、0．27，P值均大于0．05）。结论可用于修复手部电烧伤创面的皮瓣类型较多。合理选择和设计皮瓣、提高操作的熟练程度及术后正确观察与处理，是取得良好疗效的重要环节.

Objective To summarize the experiences and shortcomings of repair of wounds on hands due to electrical burns with flaps, aiming at further improvement. Methods Clinical data of 425 patients with electrical burn of hands admitted to Burn Institute of Wuhan City Hospital NO. 3 ＆ Tongren Hospital of Wuhan University from January 2000 to December 2006 were collected and summarized. Thera-peutic methods and outcomes of all patients were statistically analyzed. Flap types, complications after surgery and problems existed in patients having undergone flap transplantation were summarized. Patients were divided into surgery within 7 days post burn （PBD） group （SW） and surgery after PBD 7 group （SA） according to the timing of surgery. Survival rate of flaps and incidence of complications in patients of two groups were compared. Results Out of the 425 patients, 348 （90.2%） patients underwent surgery, among which 248 flaps of different types were transplanted in 209 patients, including 202 （81.5%） distant pedieled flaps, 19 （7.7%） local flaps, 12 （4. 8% ） free flaps, and 15 （6.0%） other kinds of tissue flaps. Five flaps failed because of necrosis or torn off, and the resulting wounds were treated with other methods. Eight flaps showed neerosis of distal margin, and the wounds healed with dressing changing or skin grafting. All the remaining flaps survived with satisfactory cosmetic and functional results. In SW group （ n = 170） and SA group （ n = 78）, survival rate of flaps was respectively 98. 8% （168/170） and 96. 2% （75/78）, incidence of complications was respectively 10.6% （18/170） and 12.8% （ 10/78）. There was no statistical difference between above two sets of data （with X2 value respectively 0.81 and 0.27, and P values both above 0.05）. Conclusions There are many types of flaps that can be used to repair electric burn wounds on hands. Appropriate choice and design of flaps, skillful operation, and careful post-operation observation and treatment are key points for good therapeutic effect.